Filtration Flashcards

0
Q

What is filtered at the glomerulus of a nephron? How much is filtered per day? How much urine is excreted per day?

A

Ultra-filtrate = water, ions, and other small molecules

180l/day filtered (every litre filtered ten times)

1.5l/day excreted

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1
Q

What is the difference between osmolality and osmolarity?

A

OSMOLALITY = solute/kg of solvent

OSMOLARITY = no. of osmoles of solute/litre

Note: functionally the same as 1kg=1l at standard conditions

Therefore, water moves from LOW OSMOLARITY solutions to HIGH OSMOLARITY solutions (low conc. of solutes to high conc.)

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2
Q

Describe what occurs at the glomerulus.

A

Water, electrolytes, & small molecules forced through by constant filtration pressure in capillaries

Thin afferent arteriole & thick efferent arteriole

Glomerular filtration rate = ~180l/day (decreased GFR indicates reduced kidney function)

Hydrostatic (tubular) & oncotic (glomerular) pressure oppose the hydrostatic pressure of the plasma (glomerular)

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3
Q

Describe what occurs at the proximal convoluted tubule (in general).

A

Major site for reabsorption by the peritubular capillaries:

  • ~60%-70% of water & Na+ (filtrate remains isotonic)
  • ~80%-90% of K+
  • ~90% of HCO3-
  • 100% of glucose & amino acids (normally)

Simple cuboidal epithelium with brush border

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4
Q

Describe what occurs at the loop of Henle.

A

Further site of reabsorption & creates increased osmolarity gradient by counter-current multiplication

Thin descending/ascending: simple squamous epithelium

  • no active transport
  • no RBCs
  • no brush border

Thick ascending: simple cuboidal epithelium

  • no brush border
  • active transport
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5
Q

Describe what occurs at the distal convoluted tubule.

A

Major site of VARIABLE reabsorption of electrolytes and water

  • reabsorbs more Na+ & Cl-
  • actively secretes H+ (therefore fluid leaving is hypotonic)
  • water may/may not follow reabsorption of electrolytes

Simple cuboidal epithelium

  • no brush border
  • numerous mitochondria
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6
Q

Describe what occurs at the collecting duct.

A

Passes through high osmolarity environment of medulla

Aquaporins present: water leaves via osmotic gradient (low volume of concentrated urine)

Aquaporins not present: water remains in urine (diuresis)

Simple cuboidal epithelium

  • no brush border
  • active transport
  • large, irregular lumen
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7
Q

How can sodium recovery be controlled? How can water recovery be controlled?

A

Sodium recovery: renin-angiotensin system (controls ECF volume)

Water recovery: ADH (controls ECF osmolarity)

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8
Q

What is the definition of a renal corpuscle?

A

Renal bodies + capillary tuft (glomerulus + Bowman’s capsule)

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9
Q

What is the duct of Bellini?

A

Merged collecting ducts -> central tube where renal pyramids converge -> open into a renal papilla -> open into a renal calyx

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10
Q

What is the structure of the Bowman’s capsule?

A

Parietal layer: simple squamous epithelium

Visceral layer: podocytes invest the capillary epithelium, forming filtration slits (spaces between podocyte processes)

note: podocytes and capillary bed share a basement membrane

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11
Q

How do blood components move from the capillary tuft into the Bowman’s capsule?

A

Capillary endothelium: filtrate (water, salts, glucose) moves between cells

Basement membrane: small proteins move through acellular gelatinous layer of collagen/glycoproteins (large proteins repelled by negative charge of glycoproteins)

Podocyte layer: pseudopodia interdigitate to form filtration slits

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12
Q

What are the key differences between cortical and juxtamedullary nephrons?

A

Cortical nephrons in cortex, juxtamedullary nephrons next to barrier between cortex and medulla

Renal artery and renal vein separate into ascending and descending vasa recta in the juxtamedullary nephrons only

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13
Q

What are the physical forces which filter plasma in the glomerulus?

A
  • Hydrostatic pressure in capillary (regulated)
  • Hydrostatic pressure in Bowman’s capsule
  • Oncotic pressure difference between the capillary & tubular lumen
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14
Q

How is the glomerular filtration rate maintained (when BP is within physiological limits)?

A

Myogenic response:
Afferent arterioles have ability to respond to changes in vessel diameter by contracting or relaxing (stretch activated, non-selective cation channels in vascular smooth muscle -> influx of calcium ions)

e.g. increase in blood pressure -> afferent arteriole constriction
increase in afferent resistance -> reduced hydrostatic pressure ->
reduced GFR

Tubular glomerular feedback:
Macula densa cells in the DCT respond to acute changes in the conc. of Na+ & Cl- (indication of tubular flow rate) by releasing chemicals from the juxtaglomerular apparatus
e.g. increase in [salt] -> adenosine released -> vasoconstriction of
afferent arterioles -> reduced GFR
decrease in [salt] -> prostaglandins released -> vasodilatation of
afferent arterioles -> increased GFR

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15
Q

Describe the actions of membrane transporters involved in reabsorption and secretion at the proximal convoluted tubule. What are the synonymous transporters in the rest of the nephron?

A

REABSORPTION:
Na+-glucose symporter moves glucose against the conc. gradient
Na+-K+-ATPase maintains sodium gradient

SECRETION:
NHE creates H+ gradient
H+ gradient drives secretion of organic ions into the tubule
Na+-K+-ATPase maintains sodium gradient

+ ROMK maintains K+ gradient

Loop of Henle: Na+-K-2Cl- symporter
Early DCT: Na+-Cl- symporter
Late DCT & collecting duct: ENaC

16
Q

Why does glucose appear in the urine in diabetics?

A

Glucose conc. in blood exceeds the transport maximum (Tm) so the not all of the glucose is reabsorbed from the urine
(RENAL THRESHOLD REACHED)

Water follows, causing polyuria

17
Q

What is renal plasma flow?

A

1 - Ht x renal blood flow = ~605ml/min of plasma

Ht = haematocrit/erythrocyte volume fraction

18
Q

What is the filtration fraction? How can this be used to calculate the glomerular filtration rate?

A

Proportion of a substance that is actually filtered = ~20% filtered

Glomerular filtration rate = 20% of renal plasma flow = 0.20 x 605
= 125ml/min

Therefore, 605 - 125 = 480ml not filtered

19
Q

What is the definition of clearance? How is this calculated?

A

Volume of plasma from which any substance is completely removed by the kidney in a given amount of time

i.e. completely cleared from the blood, none metabolised, none reabsorbed, none secreted

Therefore, a substance completely cleared from the urine has a clearance rate of 125ml/min
e.g. inulin (insoluble substance completely cleared from the urine; needs to be infused into the blood)

Clearance rate (ml/min) = Conc. of substance in urine x Urine flow rate divided by the conc. of substance in the plasma

20
Q

How is GFR estimated in patients?

A

Cockroft-Gault equation (based on patient data; adjusted for age, weight, sex)

Blood test for the conc. of creatinine in the serum

note: overestimates the GFR (creatinine secreted in PCT)
note: dependent on constant level of creatinine in serum and urine despite protein intake (so inaccurate in AKI/rapid muscle atrophy)

21
Q

What are the components and function of the juxtaglomerular apparatus?

A

Macula densa (DCT): chemoreceptors release chemicals in response to acute changes in [NaCl] (change in tubular flow rate) in order to change GFR

Lacis cells (extraglomerular mesangial cells): contract in order to constrict the renal afferent and efferent arterioles (change GFR)

Juxtaglomerular cells of afferent arteriole of glomerulus: release renin (increases GFR) (+granular cells act as mechanoreceptors)

22
Q

What is the relationship between GFR and kidney function?

A

GFR indicates how quickly a substance is filtered from the blood into the Bowman’s capsule

Therefore GFR indicates how well the kidney is filtering

23
Q

What are some of the causes of glycosuria?

A

Untreated diabetes mellitus - [glucose]blood exceeds renal threshold
note: causes increased volume of filtrate (water moves to area of greater osmolarity) —> polyuria

Pregnancy

Newborns - underdeveloped glucose reabsorption

Chronic renal failure

Renal glycosuria - reduced no. of SGLUT1/2 (benign)

Nephrotic syndrome - increased glomerular permeability

Fanconi syndrome - glucose, amino acids, uric acid, phosphate, and bicarbonate not reabsorbed

24
Q

What are some of the causes of aminoaciduria?

A

Overflow aminoaciduria - excessive levels of amino acid in blood exceed renal threshold

Renal aminoaciduria:
Generalised:
- Fanconi syndrome
- Juvenile/Acquired: heavy metal poisoning, drugs, renal diseases

Specialised:

  • Cystinuria
  • Hartnup’s disease (nicotinamide deficiency —> pellagra)